慢性胃部病变与血清胃蛋白酶原变化的临床研究

发布时间：2018-07-04 14:05

本文选题：血清胃蛋白酶原 + 幽门螺旋杆菌　；参考：《中南大学》2014年硕士论文

【摘要】：目的：检测不同胃部疾病患者血清胃蛋白酶原水平及同期健康体检人群血清胃蛋白酶原(pepsinogen,PG)水平,探讨血清胃蛋白酶原I(PGI)、血清胃蛋白酶原Ⅱ(PGⅡ)及其比值(PGⅠ/PGⅡ,PGR)在各类胃部疾病临床诊治中的意义。方法：以2012年7月至2014年3月在中南大学湘雅三医院接受胃镜检查(必要时活检)、血清胃蛋白酶原检测的健康体检人群及同期住院患者为研究对象。根据内镜加病检结果,分组如下：(A)正常对照组(B)非萎缩性胃炎组(C)慢性萎缩性胃炎组(D)胃溃疡组(E)十二指肠溃疡组(F)胃癌组。采用酶联免疫吸附法(ELISA)检测血清胃蛋白酶原水平。使用统计软件SPSS19.0进行数据统计处理,构建受试者工作特征(ROC)曲线,计算曲线下面积及临界值,结果均以p0.05为差异有统计学意义,p0.01为显著统计学差异。结果：依据纳入、排除标准,共纳入研究对象3086例。1)湖南地区汉族健康人群中,男女性之间,血清胃蛋白酶原有统计学差异(p0.05)；不同年龄组的血清胃蛋白酶原有统计学差异(p0.05)。2)健康人群中血清PG95%可信区间分别为：16～44岁女性：PGⅠ(132.44～139.26ug/L),PGⅡ(6.03～6.87ug/L),PGR(35.19～43.97)；45岁女性：PGⅠ(135.53～144.36ug/L),PGⅡ(6.72～7.54ug/L),PGR(25.54～33.34)；16～44岁男性：PGⅠ(141.18～147.86ug/L),PGⅡ(6.03～6.87ug/L),PGR(29.58～34.68)；45岁男性：PGⅠ(144.74～152.37ug/L), PGⅡ(8.83～9.86ug/L),PGR(23.16～25.88)。3)健康人群中,幽门螺旋杆菌(Hp)阳性组血清PGⅠ、PGⅡ较Hp阴性组显著增高,而PGR显著下降(p0.01)。4)PGI：与正常组、慢性萎缩性胃炎组相比,胃溃疡组PGI增高,差异有统计学意义(p0.05).5)PGⅡ:与正常组比较,慢性萎缩性胃炎组、胃癌组均呈显著增高,差异有统计学意义(p0.01)；慢性萎缩性胃炎组、胃癌组血清PGⅡ水平均高于其他各疾病组,统计学差异显著(p0.01)；慢性萎缩性胃炎组、胃癌组之间差异无统计学意义。PGⅡ从对照组→慢性非萎缩性胃炎组→慢性萎缩性胃炎组→胃癌组中呈逐渐上升趋势。6)PGR：与正常对照组相比,慢性萎缩性胃炎组、胃癌组均明显下降(p0.01),十二指肠溃疡组较对照组PGR下降(p0.05)。慢性萎缩性胃炎组、胃癌组与其他各疾病分组差异均有统计学意义(p0.01)。十二指肠溃疡组较胃溃疡组PGR值明显降低(p0.01)。PGR在正常组→慢性非萎缩性胃炎组→慢性萎缩性胃炎组→胃癌组中呈下降趋势。7)以正常对照组及胃癌组的血清胃蛋白酶原所做的受试者工作特征曲线(ROC)下的面积分别为PGⅠ0.618、PGⅡ0.860、PGR0.864。8) Hp阳性率：慢性萎缩性胃炎、胃溃疡、十二指肠溃疡组Hp感染率分别较其他组高,差异均有统计学差异(p0.05)。结论：1.湖南地区汉族健康人群中,年龄、性别、Hp均对胃蛋白酶原有影响；初步建立了本实验室血清胃蛋白酶原的医学参考范围。2.血清胃蛋白酶原可作为胃部疾病的生化检测标志物,从正常对照、慢性非萎缩性胃炎、慢性萎缩性胃炎到胃癌组,PGII呈上升趋势而PGR呈下降趋势；胃溃疡、十二指肠溃疡、慢性萎缩性胃炎组Hp感染率较高。3.低PGR值、高PGII水平与胃癌的发生密切相关,PGⅡ、PGR可作为筛查胃粘膜由萎缩到癌变这一病理学变化的血清学指标。
[Abstract]:Objective: to detect the serum pepsinogen level in patients with different gastric diseases and the level of serum pepsinogen (Pepsinogen, PG) in healthy people at the same time, and to explore the significance of serum pepsinogen I (PGI), serum pepsinogen II (PG II) and its ratio (PG I /PG II, PGR) in the clinical diagnosis and treatment of various gastric diseases.
Methods: from July 2012 to March 2014, gastroscopy was performed at Xiangya Third Hospital of Central South University (necessary biopsy), the health examination population of serum pepsinogen and patients in the same period were studied. According to the results of endoscopy and disease examination, the following groups were as follows: (A) the chronic atrophic gastritis in the normal group (B) non atrophic gastritis group (C) Group (D) gastric ulcer group (E) group of duodenal ulcer (F) gastric cancer group. Enzyme linked immunosorbent assay (ELISA) was used to detect the level of serum pepsinogen. Statistical software SPSS19.0 was used for data processing, and the working characteristics (ROC) curve of the subjects were constructed, and the product and critical value were calculated under the curve, and the results were statistically significant with P0.05 as the difference. P0.01 Significant statistical differences.
Results: according to the inclusion and exclusion criteria, 3086 cases of.1 in the Hunan Han population were included in the health population of the Han nationality in Hunan. The original statistical difference between male and female, serum pepsin (P0.05), the original statistical difference of serum pepsin (P0.05).2 in different age groups was.2) the PG95% confidence interval of the serum in the healthy Kang population was 16~44 year old women, respectively. : PG I (132.44 ~ 139.26ug/L), PG II (6.03 to 6.87ug/L), PGR (35.19 ~ 43.97); 45 year old women: PG I (135.53 to 144.36ug/L), PG II (6.72 to 7.54ug/L), PGR (25.54 to 33.34); 16~44 years old male: PG (141.18 to 147.86ug/L), 6.03 to 29.58 ~ 34.68 83 to 9.86ug/L), PGR (23.16 to 25.88).3) in the healthy population, the serum PG I in the positive group of Helicobacter pylori (Hp), PG II was significantly higher than that of the Hp negative group, while PGR decreased significantly (P0.01).4) PGI: compared with the normal group and chronic atrophic gastritis group, the PGI increased in the gastric ulcer group, and the difference was statistically significant. In the group of gastritis and gastric cancer, the difference was statistically significant (P0.01). The level of serum PG II in the chronic atrophic gastritis group and the gastric cancer group was higher than that of the other disease groups, the statistical difference was significant (P0.01); the difference between the chronic atrophic gastritis group and the gastric cancer group was no significant difference between the control group and the chronic non atrophic gastritis group. The chronic atrophic gastritis group and gastric cancer group showed a gradual increase of.6) PGR: compared with the normal control group, the chronic atrophic gastritis group and the gastric cancer group were significantly decreased (P0.01), the duodenal ulcer group was lower than the control group PGR (P0.05). The group of chronic atrophic gastritis, gastric cancer group and other disease groups had statistical significance (P0.01). The PGR value of the duodenal ulcer group was significantly lower than that of the gastric ulcer group (P0.01).PGR in the normal group, chronic non atrophic gastritis group, chronic atrophic gastritis group and gastric cancer group, which showed a decreasing trend of.7). The area of the serum pepsinogen of normal control group and gastric cancer group was PG I 0.618, PG II, respectively, and the area of the serum pepsinogen of the normal control group and the gastric cancer group was PG I 0.618. 0.860, PGR0.864.8) Hp positive rate: the rate of Hp infection in chronic atrophic gastritis, gastric ulcer and duodenal ulcer group was higher than that of other groups, the difference was statistically significant (P0.05).
Conclusion: 1. the influence of age, sex and Hp on the original gastric pepsin among healthy people of Han nationality in Hunan area, the medical reference range of serum pepsinogen in our laboratory,.2., can be used as a biochemical marker for gastric disease, from normal to chronic non atrophic gastritis and chronic atrophic gastritis. In the gastric cancer group, PGII showed an upward trend and the PGR showed a downward trend. The rate of Hp infection in gastric ulcer, duodenal ulcer and chronic atrophic gastritis was higher.3. low PGR. The high PGII level was closely related to the occurrence of gastric cancer. PG II, PGR could be used as a serological index to screen the pathological changes of gastric mucosa from atrophy to canceration.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573

【参考文献】